John Albert grew up in Los Angeles. He is an author and award winning journalist.

May 10, 2016

Doctors Who Self-Medicate

When addiction meets the psychological toll of helping others

By John Albert

Dr. Peter Grinspoon seemed like the quintessential family doctor until a visit from a cop and a DEA agent abruptly altered his life. Because of fraudulent prescriptions, Dr. Grinspoon faced three felony charges, each with the possibility of up to three years in prison and fines of $10,000, in addition to the loss of his job and suspension of his medical license. “They say the universe is gradually expanding, but at that moment my universe started collapsing,” the Harvard educated physician writes in his recently published memoir “Free Refills: A Doctor Confronts Addiction” (Hachette Books).

Physicians are portrayed as the consummate problem solvers, able to circumvent disease and sometimes even death itself. They’re held to such a high standard and they bear so much responsibility, it often takes a psychological toll. Approximately 10 to 12 percent of physicians will develop a substance abuse problem during their career. It’s a rate equal to, if not higher, than the general population.

An understandable fear of a surgeon nodding off with a scalpel in hand has inspired a system of repercussions that can be both punitive and unpredictable. Beyond the humiliation and legal ramifications, state run physician health programs are likely to strip the offender of his license to practice medicine for an undetermined amount of time. Thus, the expectations we have that doctors help others sometimes gets in the way of them helping themselves.

John Albert: What was your feeling when law enforcement showed up at your office?

Dr. Grinspoon: It was a total surprise when it happened. I knew I was screwing up, but part of the problem is I had never been caught. So when I finally did get caught it was a complete surprise. I felt mostly panic and maybe 1 percent relief.

There’s this tendency to view doctors as above mortal problems. It’s always surprising that they have the same problems as the rest of us.

Yeah, the god-like attitude, that “I’m omnipotent and never get sick and don’t ever need to ask anyone for help because I’m strong.” That attitude is such a set up — for addiction, for untreated depression, and all kinds of problems. And I think it’s ingrained in the culture of becoming a physician where you’re supposed to be the one that deals with other people’s problems, and there is never an emphasis on your own problems. We are expected to be strong and perform with robot-like efficiency. And then there is this whole cult of doctor heal thyself, where we’re really bad at asking others for help.

Dr. Peter Grinspoon

But don’t you think on some level you need that kind of exaggerated ego to be a doctor and make life or death decisions?

Yes, for sure. As a resident I was making so many life or death decisions. You even decide when someone was still alive or when exactly they died — when to stop trying to resuscitate them. If you don’t have that kind of ego you wouldn’t last a day.

Is the reality of being a physician different than the public perception?

You watch a show like ER or any of those shows, and everything that’s in the show happens, but they leave out the boring hours before anything happens. The reality is more frustrating. There’s a lot of fighting with insurance companies. We have to get permission for things. There’s a lot of barriers put in our way, to save other people money, that make our jobs increasingly more difficult. And it takes its toll on morale.

Do you think those pressures contribute to rates of addiction among physicians?

I do. When I worked at Physician Health Services, the common theme was anxiety and stress and the feeling like you aren’t getting satisfaction out of your work. There’s this phenomenon of physician burnout that nobody knows how to deal with. It’s all run by these bureaucrats who have financial incentives to deny care. Less of what we do is actually taking care of patients and more is sort of wrangling with the bureaucracy. There’s no way around it. And then you have access to all sorts of drugs. Absolutely. You could talk to your doctor about what you might need or you could just take what’s there in your office. It goes back to that culture of physician heal thy self. We’re just not good at asking for help and then we have these easily available shortcuts.

So what happens when a doctor gets in trouble for addiction? How does a doctor get his license back?

The path is completely arbitrary and that’s part of the problem. One doctor will get a DUI and the Medical Board will let him keep working, and another doctor will get a similar DUI and they will take his license away. And when doctors are in recovery they sometimes have to wait six months to get a drug test and sometimes it’s three years. It’s as if the Medical Board makes it up as they go along. Most times when you’re discovered to be addicted you have to surrender your license until you can prove with negative drug tests that you’re safe to practice. I know that they are trying to protect the public. And that’s really important. But as a physician in recovery it can feel pretty hopeless. My theory is that if you made getting help much less punitive it would be better for patient safety because you would end up intervening before the surgeon is drunk or the state police and DEA raid the their office.

Is there a noticeable stigma attached to being a doctor in recovery?

It’s hard to say.

How difficult is it for a doctor who is a recovering addict to find employment again?

I would say that it is fairly difficult. I am a very good primary care doctor and there is a shortage of primary care doctors so in a sense I had everything going for me. And still I applied to one hospital in my hometown and the head of the hospital met with me and said, “We would love to be the kind of people who would hire someone like you, but in reality we’re conservative and we’re not those people and we can’t hire you.” But then others seemed much more enlightened about addiction and aware that if you’re drug tested you are probably safer than a lot of other doctors.

Do you think being in recovery makes one a better doctor?

Absolutely. Now, I wouldn’t recommend this experience. It was no fun to go through and I caused major destruction and wasted countless resources and caused myself and my family tremendous pain. But in the end it really caused me to do a lot of soul searching. I am more connected to my patients and I care about them more.

John Alberthas written for the Los Angeles Times, LA Weekly, Fader, Black Book, and Playboy, among others, and his essays have appeared in numerous national literary anthologies. The film rights to his book “Wrecking Crew” have been optioned many times, including by the late actor Philip Seymour Hoffman. As a teenager he co-founded the seminal death rock band Christian Death and then played drums for a stint in Bad Religion.